Su Weiliang, Lu Suni, Liu Dong, Xing Jianqiang, Hu Peng, Dou Yongfeng, Geng Xiaopeng, Wang Dawei
Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shangdong, 256603, P. R. China.
Neonatal Intensive Care Unit, Binzhou People's Hospital, Binzhou Shandong, 256603, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Mar 15;39(3):346-353. doi: 10.7507/1002-1892.202412012.
To investigate the effectiveness of digital three-dimensional (3D) assisted unilateral biportal endoscopy (UBE) in the treatment of highly isolated lumbar disc herniation (LDH) with translaminar approach.
The clinical data of 59 patients who met the selection criteria and underwent UBE treatment due to highly isolated LDH between January 2022 and December 2023 were retrospectively analyzed. Among them, 25 cases were treated with digital 3D assisted translaminar approach (observation group) and 34 cases were treated with interlaminar approach (control group). There was no significant difference in gender, age, disease duration, surgical segment, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between the two groups ( >0.05). The operation time, intraoperative blood loss, and lateral articular surface preservation rate were recorded and compared between the two groups. VAS score and ODI were used to evaluate the improvements of pain and function before operation and at 3 and 6 months after operation. The modified MacNab criteria was used to evaluate the effectiveness at last follow-up.
One patient in the control group had dural tear, and the other patients had no nerve injury, infection, dural tear, or other related complications. There was no significant difference in operation time and intraoperative blood loss between the two groups ( >0.05). Patients in both groups were followed up 6-13 months, with an average of 8.3 months. The lateral articular surface preservation rate in the observation group was significantly higher than that in the control group ( <0.05). Three patients in the observation group and 2 patients in the control group had calf muscle venous thrombosis, which was cured after anticoagulant treatment with rivaroxaban and delayed exercise time. There was no recurrence or second operation during the follow-up period. The VAS score and ODI of the two groups at 3 and 6 months after operation significantly improved when compared with those before operation ( <0.05). There was no significant difference between the two groups at each time point after operation ( >0.05). At last follow-up, the effectiveness was evaluated according to the modified MacNab criteria, and there was no significant difference in the evaluation grade and excellent and good rate between the two groups ( >0.05).
UBE via translaminar approach is safe and effective for the treatment of highly isolated LDH, which is beneficial to protect the facet joint, maintain spinal stability, and reduce soft tissue injury. With the assistance of digital 3D technique, preoperative planning can be performed accurately.
探讨数字三维（3D）辅助单侧双通道内镜（UBE）经椎板间入路治疗高度游离型腰椎间盘突出症（LDH）的有效性。
回顾性分析2022年1月至2023年12月因高度游离型LDH符合入选标准并接受UBE治疗的59例患者的临床资料。其中，25例采用数字3D辅助经椎板间入路治疗（观察组），34例采用椎板间入路治疗（对照组）。两组患者在性别、年龄、病程、手术节段、术前视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）方面差异无统计学意义（>0.05）。记录并比较两组患者的手术时间、术中出血量及侧方关节突保留率。采用VAS评分和ODI评估术前及术后3、6个月疼痛和功能的改善情况。末次随访时采用改良MacNab标准评估疗效。
对照组1例患者出现硬膜撕裂，其余患者均未发生神经损伤、感染、硬膜撕裂或其他相关并发症。两组患者手术时间和术中出血量差异无统计学意义（>0.05）。两组患者均随访6~13个月，平均8.3个月。观察组侧方关节突保留率显著高于对照组（<0.05）。观察组3例患者和对照组2例患者出现小腿肌肉静脉血栓形成，经利伐沙班抗凝治疗及延长锻炼时间后治愈。随访期间无复发及二次手术情况。两组患者术后3、6个月的VAS评分和ODI较术前均显著改善（<0.05）。术后各时间点两组间差异无统计学意义（>0.05）。末次随访时，根据改良MacNab标准评估疗效，两组评估等级及优良率差异无统计学意义（>0.05）。
UBE经椎板间入路治疗高度游离型LDH安全有效，有利于保护小关节，维持脊柱稳定性，减少软组织损伤。借助数字3D技术可精确进行术前规划。
